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This comprehensive search utilized databases such as PubMed, Scopus, and Web of Science, with keywords including ME/CFS, Gut-Brain Axis, Gut Health, Intestinal Dysbiosis, Microbiome Dysbiosis, Pathophysiology, and Therapeutic Approaches. Where possible, insights from clinical trials and observational studies were included to enrich the findings

In addition to carnitines, a number of metabolically active compounds like nicotinamide, thiamine, riboflavin, creatine, and coenzyme Q10 acting at the mitochondrial level have been shown to counteract neuronal damage in conditions of ischemia, hypoxia, and metabolic compromise [85,86]

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Carnitine is a cofactor for a large family of enzymes: the carnitine acyltransferases